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Coiro S, Lacomblez C, Duarte K, Gargani L, Rastogi T, Chouihed T, Girerd N. A machine learning-based lung ultrasound algorithm for the diagnosis of acute heart failure. Intern Emerg Med 2024:10.1007/s11739-024-03627-2. [PMID: 38780749 DOI: 10.1007/s11739-024-03627-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 04/23/2024] [Indexed: 05/25/2024]
Abstract
Lung ultrasound (LUS) is an effective tool for diagnosing acute heart failure (AHF). However, several imaging protocols currently exist and how to best use LUS remains undefined. We aimed at developing a lung ultrasound-based model for AHF diagnosis using machine learning. Random forest and decision trees were generated using the LUS data (via an 8-zone scanning protocol) in patients with acute dyspnea admitted to the Emergency Department (PLUME study, N = 117) and subsequently validated in an external dataset (80 controls from the REMI study, 50 cases from the Nancy AHF cohort). Using the random forest model, total B-line sum (i.e., in both hemithoraces) was the most significant variable for identifying AHF, followed by the difference in B-line sum between the superior and inferior lung areas. The decision tree algorithm had a good diagnostic accuracy [area under the curve (AUC) = 0.865] and identified three risk groups (i.e., low 24%, high 70%, and very high-risk 96%) for AHF. The very high-risk group was defined by the presence of 14 or more B-lines in both hemithoraces while the high-risk group was described as having either B-lines mostly localized in superior points or in the right hemithorax. Accuracy in the validation cohort was excellent (AUC = 0.906). Importantly, adding the algorithm on top of a validated clinical score and classical definition of positive LUS scanning for AHF resulted in a significant improvement in diagnostic accuracy (continuous net reclassification improvement = 1.21, P < 0.001). Our simple lung ultrasound-based machine learning algorithm features an excellent performance and may constitute a validated strategy to diagnose AHF.
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Affiliation(s)
- Stefano Coiro
- Cardiology Department, Santa Maria Della Misericordia Hospital, Perugia, Italy
- Université de Lorraine, Centre D'Investigation Clinique-Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy Hopitaux de Brabois, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Institut Lorrain du Coeur Et Des Vaisseaux Louis Mathieu, 4 Rue du Morvan, 54500, Vandoeuvre Lès Nancy, France
| | - Claire Lacomblez
- Université de Lorraine, Centre D'Investigation Clinique-Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy Hopitaux de Brabois, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Institut Lorrain du Coeur Et Des Vaisseaux Louis Mathieu, 4 Rue du Morvan, 54500, Vandoeuvre Lès Nancy, France
| | - Kevin Duarte
- Université de Lorraine, Centre D'Investigation Clinique-Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy Hopitaux de Brabois, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Institut Lorrain du Coeur Et Des Vaisseaux Louis Mathieu, 4 Rue du Morvan, 54500, Vandoeuvre Lès Nancy, France
| | - Luna Gargani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Tripti Rastogi
- Université de Lorraine, Centre D'Investigation Clinique-Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy Hopitaux de Brabois, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Institut Lorrain du Coeur Et Des Vaisseaux Louis Mathieu, 4 Rue du Morvan, 54500, Vandoeuvre Lès Nancy, France
| | - Tahar Chouihed
- Emergency Department, INSERM, UMRS 1116, University Hospital of Nancy, Nancy, France
| | - Nicolas Girerd
- Université de Lorraine, Centre D'Investigation Clinique-Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy Hopitaux de Brabois, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Institut Lorrain du Coeur Et Des Vaisseaux Louis Mathieu, 4 Rue du Morvan, 54500, Vandoeuvre Lès Nancy, France.
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2
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Xirouchaki N, Bolaki M, Psarologakis C, Pediaditis E, Proklou A, Papadakis E, Kondili E, Georgopoulos D. Thoracic ultrasound use in hospitalized and ambulatory adult patients: a quantitative picture. Ultrasound J 2024; 16:11. [PMID: 38383809 PMCID: PMC10881936 DOI: 10.1186/s13089-024-00359-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 01/26/2024] [Indexed: 02/23/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES Thoracic ultrasound (TUS) has been established as a powerful diagnostic and monitoring tool in the Intensive Care Unit (ICU). However, studies outside the critical care setting are scarce. The aim of this study was to investigate the value of TUS for hospitalized or ambulatory community patients. MATERIALS AND METHODS This was a retrospective study conducted from 2016 to 2020 in the TUS clinic at Heraklion University Hospital. TUS examination was performed using a standard ultrasound machine (EUB HITACHI 8500), and a high-frequency microconvex probe (5-8 MHz). Patients had been referred by their primary physician to address a range of different questions. The various respiratory system entities were characterised according to internationally established criteria. RESULTS 762 TUS studies were performed on 526 patients due to underlying malignancy (n = 376), unexplained symptoms/signs (n = 53), pregnancy related issues (n = 42), evaluation of abnormal findings in X-ray (n = 165), recent surgery/trauma (n = 23), recent onset respiratory failure (n = 12), acute respiratory infection (n = 66) and underlying non-malignant disease (n = 25). Pleural effusion was the commonest pathologic entity (n = 610), followed by consolidation (n = 269), diaphragmatic dysfunction/paradox (n = 174) and interstitial syndrome (n = 53). Discrepancies between chest X-ray and ultrasonographic findings were demonstrated in 96 cases. The TUS findings guided invasive therapeutic management in 448 cases and non-invasive management in 43 cases, while follow-up monitoring was decided in 271 cases. CONCLUSIONS This study showed that TUS can identify the most common respiratory pathologic entities encountered in hospitalized and community ambulatory patients, and is especially useful in guiding the decision making process in a diverse group of patients.
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Affiliation(s)
- N Xirouchaki
- Intensive Care Medicine Department, University Hospital of Heraklion, University of Crete, Voutes, 71110, Heraklion, Crete, Greece.
| | - M Bolaki
- Intensive Care Medicine Department, University Hospital of Heraklion, University of Crete, Voutes, 71110, Heraklion, Crete, Greece
| | - C Psarologakis
- Intensive Care Medicine Department, University Hospital of Heraklion, University of Crete, Voutes, 71110, Heraklion, Crete, Greece
| | - E Pediaditis
- Intensive Care Medicine Department, University Hospital of Heraklion, University of Crete, Voutes, 71110, Heraklion, Crete, Greece
| | - A Proklou
- Intensive Care Medicine Department, University Hospital of Heraklion, University of Crete, Voutes, 71110, Heraklion, Crete, Greece
| | - E Papadakis
- Intensive Care Medicine Department, University Hospital of Heraklion, University of Crete, Voutes, 71110, Heraklion, Crete, Greece
| | - E Kondili
- Intensive Care Medicine Department, University Hospital of Heraklion, University of Crete, Voutes, 71110, Heraklion, Crete, Greece
| | - D Georgopoulos
- Intensive Care Medicine Department, University Hospital of Heraklion, University of Crete, Voutes, 71110, Heraklion, Crete, Greece
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Liu J. Lung Ultrasonography Does Not Distinguish between Interstitial and Alveolar Pulmonary Edema. Diagnostics (Basel) 2024; 14:324. [PMID: 38337840 PMCID: PMC10855817 DOI: 10.3390/diagnostics14030324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/23/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
For a long time, lung diseases have been considered the "forbidden zone" for ultrasound diagnosis because the lung is filled with gas, and the ultrasound waves are totally reflected when they encounter gas [...].
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Affiliation(s)
- Jing Liu
- Department of Neonatology and NICU, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
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4
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Gargani L, Girerd N, Platz E, Pellicori P, Stankovic I, Palazzuoli A, Pivetta E, Miglioranza MH, Soliman-Aboumarie H, Agricola E, Volpicelli G, Price S, Donal E, Cosyns B, Neskovic AN. Lung ultrasound in acute and chronic heart failure: a clinical consensus statement of the European Association of Cardiovascular Imaging (EACVI). Eur Heart J Cardiovasc Imaging 2023; 24:1569-1582. [PMID: 37450604 PMCID: PMC11032195 DOI: 10.1093/ehjci/jead169] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023] Open
Affiliation(s)
- Luna Gargani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, via Paradisa 2 5614, Pisa, Italy
| | - Nicolas Girerd
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, Institut Lorrain du Cœur et des Vaisseaux Louis Mathieu, CHRU de Nancy, INSERM DCAC, F-CRIN INI-CRCT, Nancy, France
| | - Elke Platz
- Cardiovascular Division, Brigham and Women’s Hospital and Harvard Medical School, Boston, USA
| | - Pierpaolo Pellicori
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Ivan Stankovic
- Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Serbia
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Cardio-Thoracic and Vascular Department, Le Scotte Hospital, University of Siena, Italy
| | - Emanuele Pivetta
- Medicina d'Urgenza-MECAU, Presidio Molinette, A.O.U. Città della Salute e della Scienza di Torino, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Marcelo Haertel Miglioranza
- EcoHaertel - Hospital Mae de Deus, Porto Alegre, Brazil
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Hatem Soliman-Aboumarie
- Department of Cardiothoracic Anaesthesia and Critical Care, Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas NHS Foundation Trust, London, UK
- School of Cardiovascular Medicine and Sciences, King’s College London, UK
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Giovanni Volpicelli
- Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy
| | - Susanna Price
- Departments of Cardiology & Intensive Care, Royal Brompton & Harefield Hospitals, Guy’s and St Thomas NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, UK
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, Rennes, France
| | - Bernard Cosyns
- Department of Cardiology, Universitair Ziekenhuis Brussel, Jette, Brussels, Belgium
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Arnone MI, Sforza A, Carlino MV, Guarino M, Candido R, Bertolone D, Fucile I, De Luca N, Mancusi C. Assessment of E/A ratio helps emergency clinicians in the management of patients with acute dyspnea. Intern Emerg Med 2023; 18:1823-1830. [PMID: 37103762 PMCID: PMC10504390 DOI: 10.1007/s11739-023-03279-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 04/14/2023] [Indexed: 04/28/2023]
Abstract
Acute dyspnea (AD) is one of the main reasons for admission to the Emergency Department (ED). In the last years integrated ultrasound examination (IUE) of lung, heart and inferior vena cava (IVC) has become an extension of clinical examination for a fast differential diagnosis. The aim of present study is to assess the feasibility and diagnostic accuracy of E/A ratio for diagnosing acute heart failure (aHF) in patients with acute dyspnea. We included 92 patients presenting to the ED of CTO Hospital in Naples (Italy) for AD. All patients underwent IUE of lung-heart-IVC with a portable ultrasound device. Left ventricle diastolic function was assessed using pulse wave doppler at the tips of the mitral valve and E wave velocity and E/A ratio were recorded. The FINAL diagnosis was determined by two expert reviewers: acute HF or non-acute HF (non-aHF). We used 2 × 2 contingency tables to analyze sensitivity, specificity, positive predictive and negative predictive value of ultrasound parameters for the diagnosis of AD, comparing with the FINAL diagnosis. Lung ultrasound (LUS) showed high sensitivity, good specificity and accuracy in identification of patients with aHF. However, the highest accuracy was obtained by diastolic function parameters. The E/A ratio showed the highest diagnostic performance with an AUC for aHF of 0.93. In patients presenting with AD, E/A ratio is easy to obtain in a fast ultrasound protocol and showed an excellent accuracy for diagnosis of aHF.
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Affiliation(s)
| | - Alfonso Sforza
- Cardiology Department and Cardiology Intensive Care Unit, Santa Maria Delle Grazie, Pozzuoli, Italy
| | - Maria Viviana Carlino
- Cardiology Department and Cardiology Intensive Care Unit, San Giuliano Hospital, Giugliano, Italy
| | | | | | - Dario Bertolone
- Emergency Medicine School & Department of Advanced Biomedical Science, Federico II University Hospital, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Ilaria Fucile
- Emergency Medicine School & Department of Advanced Biomedical Science, Federico II University Hospital, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Nicola De Luca
- Emergency Medicine School & Department of Advanced Biomedical Science, Federico II University Hospital, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Costantino Mancusi
- Emergency Medicine School & Department of Advanced Biomedical Science, Federico II University Hospital, Via Sergio Pansini 5, 80131, Naples, Italy.
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Baloescu C, Rucki AA, Chen A, Zahiri M, Ghoshal G, Wang J, Chew R, Kessler D, Chan DKI, Hicks B, Schnittke N, Shupp J, Gregory K, Raju B, Moore C. Machine Learning Algorithm Detection of Confluent B-Lines. ULTRASOUND IN MEDICINE & BIOLOGY 2023:S0301-5629(23)00173-4. [PMID: 37365065 DOI: 10.1016/j.ultrasmedbio.2023.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/02/2023] [Accepted: 05/26/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE B-lines are a ring-down artifact of lung ultrasound that arise with increased alveolar water in conditions such as pulmonary edema and infectious pneumonitis. Confluent B-line presence may signify a different level of pathology compared with single B-lines. Existing algorithms aimed at B-line counting do not distinguish between single and confluent B-lines. The objective of this study was to test a machine learning algorithm for confluent B-line identification. METHODS This study used a subset of 416 clips from 157 subjects, previously acquired in a prospective study enrolling adults with shortness of breath at two academic medical centers, using a hand-held tablet and a 14-zone protocol. After exclusions, random sampling generated a total of 416 clips (146 curvilinear, 150 sector and 120 linear) for review. A group of five experts in point-of-care ultrasound blindly evaluated the clips for presence/absence of confluent B-lines. Ground truth was defined as majority agreement among the experts and used for comparison with the algorithm. RESULTS Confluent B-lines were present in 206 of 416 clips (49.5%). Sensitivity and specificity of confluent B-line detection by algorithm compared with expert determination were 83% (95% confidence interval [CI]: 0.77-0.88) and 92% (95% CI: 0.88-0.96). Sensitivity and specificity did not statistically differ between transducers. Agreement between algorithm and expert for confluent B-lines measured by unweighted κ was 0.75 (95% CI: 0.69-0.81) for the overall set. CONCLUSION The confluent B-line detection algorithm had high sensitivity and specificity for detection of confluent B-lines in lung ultrasound point-of-care clips, compared with expert determination.
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Affiliation(s)
- Cristiana Baloescu
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | | | - Alvin Chen
- Philips Research North America, Cambridge, MA, USA
| | | | | | - Jing Wang
- Philips Research North America, Cambridge, MA, USA
| | - Rita Chew
- Philips Research North America, Cambridge, MA, USA
| | - David Kessler
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Daniela K I Chan
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA; Center for Regenerative Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Bryson Hicks
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA; Center for Regenerative Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Nikolai Schnittke
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA; Center for Regenerative Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Jeffrey Shupp
- Departments of Surgery, Biochemistry and Molecular & Cellular Biology, Georgetown University School of Medicine | Medstar Health, Washington, DC, USA
| | - Kenton Gregory
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA; Center for Regenerative Medicine, Oregon Health & Science University, Portland, OR, USA
| | | | - Christopher Moore
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
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Platz E, Claggett B, Jering KS, Kovacs A, Cikes M, Winzer EB, Rad A, Lefkowitz MP, Gong J, Køber L, McMurray JJV, Solomon SD, Pfeffer MA, Shah A. Trajectory and correlates of pulmonary congestion by lung ultrasound in patients with acute myocardial infarction: insights from PARADISE-MI. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2023; 12:155-164. [PMID: 36649251 PMCID: PMC10319964 DOI: 10.1093/ehjacc/zuad001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/06/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023]
Abstract
AIM PARADISE-MI examined the efficacy of sacubitril/valsartan in acute myocardial infarction (AMI) complicated by reduced left ventricular ejection fraction (LVEF), pulmonary congestion, or both. We sought to assess the trajectory of pulmonary congestion using lung ultrasound (LUS) and its association with cardiac structure and function in a pre-specified substudy. METHODS AND RESULTS Patients without prior heart failure (HF) underwent eight-zone LUS and echocardiography at baseline (±2 days of randomization) and after 8 months. B-lines were quantified offline, blinded to treatment, clinical findings, time point, and outcomes. Among 152 patients (median age 65, 32% women, mean LVEF 41%), B-lines were detectable in 87% at baseline [median B-line count: 4 (interquartile range 2-8)]. Among 115 patients with LUS data at baseline and follow-up, B-lines decreased significantly from baseline (mean ± standard deviation: -1.6 ± 7.3; P = 0.018). The proportion of patients without pulmonary congestion at follow-up was significantly higher in those with fewer B-lines at baseline. Adjusted for baseline, B-lines at follow-up were on average 6 (95% confidence interval: 3-9) higher in patients who experienced an intercurrent HF event vs. those who did not (P = 0.001). A greater number of B-lines at baseline was associated with larger left atrial size, higher E/e' and E/A ratios, greater degree of mitral regurgitation, worse right ventricular systolic function, and higher tricuspid regurgitation velocity (P-trend <0.05 for all). CONCLUSION In this AMI cohort, B-lines, indicating pulmonary congestion, were common at baseline and, on average, decreased significantly from baseline to follow-up. Worse pulmonary congestion was associated with prognostically important echocardiographic markers.
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Affiliation(s)
- Elke Platz
- Cardiovascular Division, Brigham and Women’s Hospital, 360 Longwood Ave, 7th Floor, Boston, MA 02115, USA
| | - Brian Claggett
- Cardiovascular Division, Brigham and Women’s Hospital, 360 Longwood Ave, 7th Floor, Boston, MA 02115, USA
| | - Karola S Jering
- Cardiovascular Division, Brigham and Women’s Hospital, 360 Longwood Ave, 7th Floor, Boston, MA 02115, USA
| | - Attila Kovacs
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Maja Cikes
- Department of Cardiovascular Diseases, University of Zagreb School of Medicine and University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ephraim B Winzer
- Heart Center Dresden—University Clinic, Department of Internal Medicine and Cardiology, Technische Universität Dresden, Dresden, Germany
| | - Aria Rad
- Cardiovascular Division, Brigham and Women’s Hospital, 360 Longwood Ave, 7th Floor, Boston, MA 02115, USA
| | | | - Jianjian Gong
- Novartis Pharmaceutical Corporation, East Hanover, NJ, USA
| | - Lars Køber
- Rigshospitalet, Blegdamsvej, University of Copenhagen, Copenhagen, Denmark
| | - John J V McMurray
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women’s Hospital, 360 Longwood Ave, 7th Floor, Boston, MA 02115, USA
| | - Marc A Pfeffer
- Cardiovascular Division, Brigham and Women’s Hospital, 360 Longwood Ave, 7th Floor, Boston, MA 02115, USA
| | - Amil Shah
- Cardiovascular Division, Brigham and Women’s Hospital, 360 Longwood Ave, 7th Floor, Boston, MA 02115, USA
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Abstract
Point-of-care ultrasound (POCUS) has evolved in recent years in clinical practice, helping in early bedside diagnosis of important etiologies. Many medical schools and training programs are integrating POCUS into their curriculum. Especially with the technological advances of newer handheld ultrasound devices, POCUS has now become a component adjunct to clinical examination, in the clinic and bedside in critical care units. The diagnostic utility of POCUS lies both in early identification of critical kidney disease, and also extra-renal pathologies from a focused cardiac ultrasound, lung ultrasound, and integrated fluid assessment. There is a need to incorporate POCUS in training in pediatric nephrology and establish competency standard criteria. This review shall cover how POCUS helps in enhancing patient care in pediatric kidney disorders and critical children, and the recent advances.
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Emergency department risk assessment and disposition of acute heart failure patients: existing evidence and ongoing challenges. Heart Fail Rev 2022:10.1007/s10741-022-10272-4. [PMID: 36123519 PMCID: PMC9485013 DOI: 10.1007/s10741-022-10272-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 12/02/2022]
Abstract
Heart failure (HF) is a global public health burden, characterized by frequent emergency department (ED) visits and hospitalizations. Identifying successful strategies to avoid admissions is crucial for the management of acutely decompensated HF, let alone resource utilization. The primary challenge for ED management of patients with acute heart failure (AHF) lies in the identification of those who can be safely discharged home instead of being admitted. This is an elaborate decision, based on limited objective evidence. Thus far, current biomarkers and risk stratification tools have had little impact on ED disposition decision-making. A reliable definition of a low-risk patient profile is warranted in order to accurately identify patients who could be appropriate for early discharge. A brief period of observation can facilitate risk stratification and allow for close monitoring, aggressive treatment, continuous assessment of response to initial therapy and patient education. Lung ultrasound may represent a valid bedside tool to monitor cardiogenic pulmonary oedema and determine the extent of achieved cardiac unloading after treatment in the observation unit setting. Safe discharge mandates multidisciplinary collaboration and thoughtful assessment of socioeconomic and behavioural factors, along with a clear post-discharge plan put forward and a close follow-up in an outpatient setting. Ongoing research to improve ED risk stratification and disposition of AHF patients may mitigate the tremendous public health challenge imposed by the HF epidemic.
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Arvig MD, Laursen CB, Jacobsen N, Gæde PH, Lassen AT. Monitoring patients with acute dyspnea with serial point-of-care ultrasound of the inferior vena cava (IVC) and the lungs (LUS): a systematic review. J Ultrasound 2022; 25:547-561. [PMID: 35040102 PMCID: PMC9402857 DOI: 10.1007/s40477-021-00622-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The primary aim was to investigate if treatment guided by serial ultrasound of the inferior vena cava-collapsibility index (IVC-CI) and B-lines on lung ultrasound (LUS) could reduce mortality, readmissions, and length of stay (LOS) in acutely dyspneic patients admitted to a hospital, compared to standard monitoring. The secondary aim was to determine how the changes of B-lines and IVC-CI are correlated to vitals and symptoms. METHODS A systematic search was conducted on PubMed, Embase, Cochrane, Google Scholar, Web of Science, Scopus, OpenGrey, ProQuest, and databases for ongoing trials. The risk of bias was assessed according to study design. RESULTS Of the 8258 studies identified, 50 were selected for full-text screening, and 24 studies were chosen for data extraction (19 pre-post-, two non-randomized controlled-, two randomized controlled-, and one retrospective cohort study), covering 2040 patients. Most studies were single-center and had small study populations with only heart failure patients. The risk of bias was high. No studies evaluated how the difference between two ultrasound measurements correlated with the primary outcomes. Seven studies reported that a decline in either B-lines or IVC size, or an increased IVC-CI reduced mortality, readmissions, and LOS when correlated to a single ultrasound measurement. All studies showed changes in the IVC-CI and B-lines, but these were not related to vitals or symptoms. CONCLUSION B-lines and IVC-CI are dynamic variables that change over time and with treatment. A single ultrasound measurement can influence prognostic outcomes, but it remains uncertain if repeated scans can have the same impact.
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Affiliation(s)
- Michael Dan Arvig
- Department of Emergency Medicine, Slagelse Hospital, Slagelse, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Christian B Laursen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Niels Jacobsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Regional Center for Technical Simulation, TechSim, Odense, Denmark
| | - Peter Haulund Gæde
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark
| | - Annmarie Touborg Lassen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
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Torres-Macho J, Cerqueiro-González JM, Arévalo-Lorido JC, Llácer-Iborra P, Cepeda-Rodrigo JM, Cubo-Romano P, Casas-Rojo JM, Ruiz-Ortega R, Manzano-Espinosa L, Lorenzo-Villalba N, Méndez-Bailón M. The Effects of a Therapeutic Strategy Guided by Lung Ultrasound on 6-Month Outcomes in Patients with Heart Failure: Results from the EPICC Randomized Controlled Trial. J Clin Med 2022; 11:jcm11164930. [PMID: 36013168 PMCID: PMC9409707 DOI: 10.3390/jcm11164930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Pulmonary congestion (PC) is associated with an increased risk of hospitalization and death in patients with heart failure (HF). Lung ultrasound is highly sensitive for detecting PC. The aim of this study is to evaluate whether lung ultrasound-guided therapy improves 6-month outcomes in patients with HF. Methods: A randomized, multicenter, single-blind clinical trial in patients discharged after hospitalization for decompensated HF. Participants were assigned 1:1 to receive treatment guided according to the presence of lung ultrasound signs of congestion (semi-quantitative evaluation of B lines and the presence of pleural effusion) versus standard of care (SOC). The primary endpoint was the combination of cardiovascular death, readmission, or emergency department or day hospital visit due to worsening HF at 6 months. In September 2020, after an interim analysis, patient recruitment was stopped. Results: A total of 79 patients were randomized (mean age 81.2 +/− 9 years) and 41 patients (51.8%) showed a left ventricular ejection fraction >50%. The primary endpoint occurred in 11 patients (29.7%) in the SOC group and in 11 patients (26.1%) in the LUS group (log-rank = 0.83). Regarding nonserious adverse events, no significant differences were found. Conclusions: LUS-guided diuretic therapy after hospital discharge due to ADHF did not show any benefit in survival or a need for intravenous diuretics compared with SOC.
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Affiliation(s)
- Juan Torres-Macho
- Internal Medicine Department, Hospital Universitario Infanta Leonor-Virgen de la Torre, 28031 Madrid, Spain
- Correspondence:
| | | | | | - Pau Llácer-Iborra
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | | | - Pilar Cubo-Romano
- Internal Medicine Department, Hospital Universitario Infanta Cristina, 28981 Madrid, Spain
| | - Jose Manuel Casas-Rojo
- Internal Medicine Department, Hospital Universitario Infanta Cristina, 28981 Madrid, Spain
| | - Raúl Ruiz-Ortega
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Luis Manzano-Espinosa
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Noel Lorenzo-Villalba
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Manuel Méndez-Bailón
- Internal Medicine Department, Hospital Universitario Clínico San Carlos, 28040 Madrid, Spain
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12
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Seiler C, Kristiansson L, Klingberg C, Sundh J, Braman Eriksson A, Lundeqvist D, Nilsson KF, Hårdstedt M. Swimming-Induced Pulmonary Edema: Evaluation of Prehospital Treatment With CPAP or Positive Expiratory Pressure Device. Chest 2022; 162:410-420. [PMID: 35288117 PMCID: PMC9424325 DOI: 10.1016/j.chest.2022.02.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Swimming-induced pulmonary edema (SIPE) occasionally occurs during swimming in cold open water. Although optimal treatment for SIPE is unknown, non-invasive positive pressure ventilation (NPPV) is an option for prehospital treatment. RESEARCH QUESTION Is NPPV a feasible and safe prehospital treatment for SIPE, and which outcome measures reflect recovery after treatment? STUDY DESIGN AND METHODS A prospective observational study was conducted at Vansbrosimningen, Sweden's largest open water swimming event, from 2017 through 2019. Swimmers with a diagnosis of SIPE and with peripheral oxygen saturation (Spo2) of ≤ 95%, persistent respiratory symptoms, or both were eligible for the study. NPPV was administered on site as CPAP by facial mask or as positive expiratory pressure (PEP) by a PEP device. Discharge criteria were Spo2 of > 95% and clinical recovery. Four outcome measures were evaluated: Spo2, crackles on pulmonary auscultation, pulmonary edema on lung ultrasound (LUS), and patient-reported respiratory symptoms. RESULTS Of 119 treated individuals, 94 received CPAP, 24 received treatment with a PEP device, and one required tracheal intubation. In total, 108 individuals (91%) were discharged after NPPV for a median of 10 to 20 min and 11 individuals (9%) required hospital transfer. NPPV resulted in increased Spo2 from a median of 91% to 97% (P < .0001) together with improvement of six patient-reported respiratory symptoms (median numerical rating scales, 1-7 to 0-1; P < .0001). No significant decrease in auscultation of crackles (93% vs 87%; P = .508) or pulmonary edema on LUS (100% vs 97%; P = .500) was seen during NPPV treatment. INTERPRETATION NPPV administered as CPAP or via a PEP device proved feasible and safe as prehospital treatment for SIPE with a vast majority of patients discharged on site. Spo2 and patient-reported respiratory symptoms reflected recovery after treatment, whereas pulmonary auscultation or LUS findings did not.
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Affiliation(s)
- Claudia Seiler
- Department of Anesthesiology and Intensive Care, Falun Hospital, Falun, Sweden; Center for Clinical Research Dalarna-Uppsala University, Falun, Sweden; School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Linda Kristiansson
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Sandviken North Primary Health Care Center, Sandviken, Sweden; Center for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Cecilia Klingberg
- Department of Anesthesiology and Intensive Care, Falun Hospital, Falun, Sweden
| | - Josefin Sundh
- Department of Respiratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | | | - Kristofer F Nilsson
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Maria Hårdstedt
- Center for Clinical Research Dalarna-Uppsala University, Falun, Sweden; School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Vansbro Primary Health Care Center, Vansbro, Sweden
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13
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Ruangsomboon O, Praphruetkit N, Monsomboon A. Parallel-group, randomised, controlled, non-inferiority trial of high-flow nasal cannula versus non-invasive ventilation for emergency patients with acute cardiogenic pulmonary oedema: study protocol. BMJ Open 2022; 12:e052761. [PMID: 35798514 PMCID: PMC9263936 DOI: 10.1136/bmjopen-2021-052761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION High-flow nasal cannula (HFNC) is an innovative oxygen-delivering technique, which has been shown to effectively decrease the intubation risk in patients with hypoxaemic respiratory failure of various aetiologies compared with conventional oxygen therapy. Also, it has proved to be non-inferior to non-invasive positive pressure ventilation (NIPPV) in patients with hypoxaemic respiratory failure primarily due to pneumonia. Evidence on its benefits compared with NIPPV, which is the standard of care for patients with acute cardiogenic pulmonary oedema (ACPE) with hypoxaemic respiratory distress, is limited. Therefore, we planned this study to investigate the effects of HFNC compared with NIPPV for emergency patients with ACPE. METHODS AND ANALYSIS In this single-centred, non-blinded, parallel-group, randomised, controlled, non-inferiority trial, we will randomly allocate 240 patients visiting the emergency department with ACPE in a 1:1 ratio to receive either HFNC or NIPPV for at least 4 hours using computer-generated mixed-block randomisation concealed by sealed opaque envelopes. The primary outcome is the intubation rate in 72 hours after randomisation. The main secondary outcomes are intolerance rate, mortality rate and treatment failure rate (a composite of intolerance, intubation and mortality). The outcome assessors and data analysts will be blinded to the intervention. These categorical outcomes will be analysed by calculating the risk ratio. Interim analyses evaluating the primary outcome will be performed after half of the expected sample size are recruited. ETHICS AND DISSEMINATION This study protocol has been approved by the Siriraj Institutional Review Board (study ID: Si 271/2021). It has been granted the Siriraj Research and Development Fund. All participants or their authorised third parties will provide written informed consent prior to trial inclusion. The study results will be published in a peer-reviewed international journal and presented at national and international scientific conferences. TRIAL REGISTRATION NUMBER TCTR20210413001.
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Affiliation(s)
- Onlak Ruangsomboon
- Department of Emergency Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nattakarn Praphruetkit
- Department of Emergency Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Apichaya Monsomboon
- Department of Emergency Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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14
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Cogliati C, Ceriani E, Gambassi G, De Matteis G, Perlini S, Perrone T, Muiesan ML, Salvetti M, Leidi F, Ferrara F, Sabbà C, Suppressa P, Fracanzani A, Montano N, Fiorelli E, Tripepi G, Gori M, Pitino A, Pietrangelo A. Phenotyping congestion in patients with acutely decompensated heart failure with preserved and reduced ejection fraction: The Decongestion duRing therapY for acute decOmpensated heart failure in HFpEF vs HFrEF- DRY-OFF study. Eur J Intern Med 2022; 97:69-77. [PMID: 34844795 DOI: 10.1016/j.ejim.2021.11.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 12/20/2022]
Abstract
AIMS To evaluate pulmonary and intravascular congestion at admission and repeatedly during hospitalization for acute decompensated heart failure (ADHF) in HFrEF and HFpEF patients using lung (LUS) and inferior vena cava (IVC) ultrasound. METHODS AND RESULTS Three-hundred-fourteen patients (82±9 years; HFpEF =172; HFrEF=142) admitted to Internal Medicine wards for ADHF were enrolled in a multi-center prospective study. At admission HFrEF presented higher indexes of pulmonary and intravascular congestion (LUS-score: 0.9 ± 0.4 vs 0.7 ± 0.4; p<0.01; IVC end-expiratory diameter: 21.6 ± 5.1 mm vs 20±5.5 mm, p<0.01; IVC collapsibility index 24.4 ± 17.4% vs 30.9 ± 21.1% p<0.01) and higher Nt-proBNP values (8010 vs 3900 ng/l; p<0.001). At discharge, HFrEF still presented higher B-scores (0.4 ± 4 vs 0.3 ± 0.4; p = 0.023), while intravascular congestion improved to a greater extent, thus IVC measurements were similar in the two groups. No differences in diuretic doses, urine output, hemoconcentration, worsening renal function were found. At 90-days follow up HF readmission/death did not differ in HFpEF and HFrEF (28% vs 31%, p = 0,48). Residual congestion was associated with HF readmission/death considering the whole population; while intravascular congestion predicted readmission/death in the HFrEF, no association between sonographic indexes and the outcome was found in HFpEF. CONCLUSIONS Serial assessment of pulmonary and intravascular congestion revealed a higher burden of fluid overload in HFrEF and, conversely, a greater reduction in intravascular venous congestion with diuretic treatment. Although other factors beyond EF could play a role in congestion/decongestion patterns, our data may be relevant for further phenotyping HF patients, considering the importance of decongestion optimization in the clinical approach.
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Affiliation(s)
- C Cogliati
- Department of Biomedical and Clinical Sciences, University of Milan, ASST Fatebenefratelli- Sacco, Italy
| | - E Ceriani
- Department of Biomedical and Clinical Sciences, University of Milan, ASST Fatebenefratelli- Sacco, Italy.
| | - G Gambassi
- Department of Medicine and Traslational Surgery, Università Cattolica del Sacro Cuore Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - G De Matteis
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - S Perlini
- Emergency Department, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy
| | - T Perrone
- Internal Medicine 1, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy
| | - M L Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia-ASST Spedali Civili Brescia, Brescia, Italy
| | - M Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia-ASST Spedali Civili Brescia, Brescia, Italy
| | - F Leidi
- Department of Biomedical and Clinical Sciences, University of Milan, ASST Fatebenefratelli- Sacco, Italy
| | - F Ferrara
- Department of Internal and Emergency Medicine, University Hospital of Modena, Italy
| | - C Sabbà
- Division of Internal Medicine and Geriatrics, DIM Department, University of Bari, Italy
| | - P Suppressa
- Division of Internal Medicine and Geriatrics, DIM Department, University of Bari, Italy
| | - A Fracanzani
- Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Italy
| | - N Montano
- Department of Clinical Sciences and Health Community, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Italy
| | - E Fiorelli
- Department of Clinical Sciences and Health Community, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Italy
| | - G Tripepi
- Institute of Clinical Physiology (IFC-CNR), Section of Reggio Calabria, Italy
| | - M Gori
- Institute of Clinical Physiology (IFC-CNR), Section of Rome, Italy
| | - A Pitino
- Institute of Clinical Physiology (IFC-CNR), Section of Rome, Italy
| | - A Pietrangelo
- Department of Internal and Emergency Medicine, University Hospital of Modena, Italy
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15
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Assessment of fluid unresponsiveness guided by lung ultrasound in abdominal surgery: a prospective cohort study. Sci Rep 2022; 12:1350. [PMID: 35079044 PMCID: PMC8789825 DOI: 10.1038/s41598-022-05251-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 01/10/2022] [Indexed: 12/02/2022] Open
Abstract
A fluid challenge can generate an infraclinical interstitial syndrome that may be detected by the appearance of B-lines by lung ultrasound. Our objective was to evaluate the appearance of B-lines as a diagnostic marker of preload unresponsiveness and postoperative complications in the operating theater. We conducted a prospective, bicentric, observational study. Adult patients undergoing abdominal surgery were included. Stroke volume (SV) was determined before and after a fluid challenge with 250 mL crystalloids (Delta-SV) using esophageal Doppler monitoring. Responders were defined by an increase of Delta-SV > 10% after fluid challenge. B-lines were collected at four bilateral predefined zones (right and left anterior and lateral). Delta-B-line was defined as the number of newly appearing B-lines after a fluid challenge. Postoperative pulmonary complications were prospectively recorded according to European guidelines. In total, 197 patients were analyzed. After a first fluid challenge, 67% of patients were responders and 33% were non-responders. Delta-B-line was significantly higher in non-responders than responders [4 (2–7) vs 1 (0–3), p < 0.0001]. Delta-B-line was able to diagnose fluid non-responders with an area under the curve of 0.74 (95% CI 0.67–0.80, p < 0.0001). The best threshold was two B-lines with a sensitivity of 80% and a specificity of 57%. The final Delta-B-line could predict postoperative pulmonary complications with an area under the curve of 0.74 (95% CI 0.67–0.80, p = 0.0004). Delta-B-line of two or more detected in four lung ultrasound zones can be considered to be a marker of preload unresponsiveness after a fluid challenge in abdominal surgery. The objectives and procedures of the study were registered at Clinicaltrials.gov (NCT03502460; Principal investigator: Stéphane BAR, date of registration: April 18, 2018).
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16
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Lindner M, Lindsey A, Bain PA, Platz E. Prevalence and prognostic importance of lung ultrasound findings in acute coronary syndrome: A systematic review. Echocardiography 2021; 38:2069-2076. [PMID: 34845749 DOI: 10.1111/echo.15262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/03/2021] [Accepted: 11/06/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Heart failure (HF) complicating acute coronary syndrome (ACS) is a herald of adverse outcomes. In this systematic review, we investigated the prevalence of lung ultrasound (LUS) findings and their prognostic utility among patients with ACS. METHODS We searched the online databases PubMed, EMBASE, and Web of Science for studies (full-text articles, published in English) that used LUS in adult patients with ACS [ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina]. RESULTS Of 462 studies screened, five prospective, observational investigations published between 2010 and 2021 including 1087 patients met our inclusion criteria. Two studies employed 28-zone imaging protocols whereas three used eight-zone protocols. The proportion of patients with a prior HF diagnosis was ≤ 5% in all studies. The prevalence of B-lines was examined prior to or within 12 hours after coronary angiogram and reporting varied between studies due to different imaging protocols or quantification methods. A higher number of B-lines on admission was associated with an increased risk for developing symptomatic HF during the baseline hospitalization and with a higher in-hospital mortality rate using either 8 or 28-zone protocols. A higher number of B-lines at baseline was also associated with an increased risk of subsequent HF hospitalization or all-cause death. CONCLUSIONS Pulmonary congestion by LUS performed on admission appears to be a common finding among patients hospitalized for ACS and is associated with adverse in-hospital and long-term outcomes. Further investigations using standardized LUS protocols are warranted and have the potential to improve risk stratification in ACS.
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Affiliation(s)
| | - Anika Lindsey
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Paul A Bain
- Countway Library of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Elke Platz
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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17
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Li N, Zhu Y, Zeng J. Clinical value of pulmonary congestion detection by lung ultrasound in patients with chronic heart failure. Clin Cardiol 2021; 44:1488-1496. [PMID: 34599512 PMCID: PMC8571545 DOI: 10.1002/clc.23738] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/19/2021] [Accepted: 09/22/2021] [Indexed: 12/12/2022] Open
Abstract
Chronic heart failure is one of the common causes of hospitalization and death. Pulmonary congestion is the common disease feature of patients with chronic heart failure, which could be correctly diagnosed by lung ultrasound. Efficacy of lung ultrasound‐guided pulmonary congestion management for patients with acute heart failure is well documented, however, more evidence is needed to establish the clinical value of pulmonary congestion detection by lung ultrasound examination in patients with chronic heart failure. This review summarized current evidence related to the use and clinical value of pulmonary congestion assessment by lung ultrasound in patients with chronic heart failure, aiming to provide new suggestions on promoting the widespread use of lung ultrasound in patients with chronic heart failure to improve the quality of life and outcome of patients with chronic heart failure.
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Affiliation(s)
- Na Li
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, China.,Center of Cooperative Postgraduate Cultivation in Xiangtan Central Hospital, University of South China, Xiangtan, China
| | - Yunlong Zhu
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, China
| | - Jianping Zeng
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, China.,Center of Cooperative Postgraduate Cultivation in Xiangtan Central Hospital, University of South China, Xiangtan, China
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18
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Argaiz ER, Koratala A, Reisinger N. Comprehensive Assessment of Fluid Status by Point-of-Care Ultrasonography. KIDNEY360 2021; 2:1326-1338. [PMID: 35369665 PMCID: PMC8676400 DOI: 10.34067/kid.0006482020 10.34067/kid.0006482020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 01/10/2024]
Abstract
The management of complex fluid and electrolyte disorders is central to the practice of nephrologists. The sensitivity of physical examination alone to determine fluid status is limited, precluding accurate clinical decision making. Point-of-care ultrasonography (POCUS) is emerging as a valuable, noninvasive, bedside diagnostic tool for objective evaluation of physiologic and hemodynamic parameters related to fluid status, tolerance, and responsiveness. Rapid bedside sonographic evaluation can obtain qualitative data on cardiac function and quantitative data on pulmonary congestion. Advanced POCUS, including goal-directed Doppler echocardiography, provides additional quantitative information, including flow velocities and pressures across the cardiac structures. Recently, abnormal Doppler flow patterns in abdominal organs secondary to increased right atrial pressure have been linked to congestive organ damage, adding another component to the hemodynamic assessment. Integrating POCUS findings with clinical and laboratory data can further elucidate a patient's hemodynamic status. This drives decisions regarding crystalloid administration or, conversely, diuresis or ultrafiltration and allows tailored therapy for individual patients. In this article, we provide an overview of the focused assessment of cardiovascular function and pulmonary and venous congestion using POCUS and review relevant literature.
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Affiliation(s)
- Eduardo R. Argaiz
- National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
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19
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Argaiz ER, Koratala A, Reisinger N. Comprehensive Assessment of Fluid Status by Point-of-Care Ultrasonography. KIDNEY360 2021; 2:1326-1338. [PMID: 35369665 PMCID: PMC8676400 DOI: 10.34067/kid.0006482020] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 02/06/2023]
Abstract
The management of complex fluid and electrolyte disorders is central to the practice of nephrologists. The sensitivity of physical examination alone to determine fluid status is limited, precluding accurate clinical decision making. Point-of-care ultrasonography (POCUS) is emerging as a valuable, noninvasive, bedside diagnostic tool for objective evaluation of physiologic and hemodynamic parameters related to fluid status, tolerance, and responsiveness. Rapid bedside sonographic evaluation can obtain qualitative data on cardiac function and quantitative data on pulmonary congestion. Advanced POCUS, including goal-directed Doppler echocardiography, provides additional quantitative information, including flow velocities and pressures across the cardiac structures. Recently, abnormal Doppler flow patterns in abdominal organs secondary to increased right atrial pressure have been linked to congestive organ damage, adding another component to the hemodynamic assessment. Integrating POCUS findings with clinical and laboratory data can further elucidate a patient's hemodynamic status. This drives decisions regarding crystalloid administration or, conversely, diuresis or ultrafiltration and allows tailored therapy for individual patients. In this article, we provide an overview of the focused assessment of cardiovascular function and pulmonary and venous congestion using POCUS and review relevant literature.
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Affiliation(s)
- Eduardo R. Argaiz
- National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
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20
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Patrician A, Pernett F, Lodin-Sundström A, Schagatay E. Association Between Arterial Oxygen Saturation and Lung Ultrasound B-Lines After Competitive Deep Breath-Hold Diving. Front Physiol 2021; 12:711798. [PMID: 34421654 PMCID: PMC8371971 DOI: 10.3389/fphys.2021.711798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/12/2021] [Indexed: 12/22/2022] Open
Abstract
Breath-hold diving (freediving) is an underwater sport that is associated with elevated hydrostatic pressure, which has a compressive effect on the lungs that can lead to the development of pulmonary edema. Pulmonary edema reduces oxygen uptake and thereby the recovery from the hypoxia developed during freediving, and increases the risk of hypoxic syncope. We aimed to examine the efficacy of SpO2, via pulse-oximetry, as a tool to detect pulmonary edema by comparing it to lung ultrasound B-line measurements after deep diving. SpO2 and B-lines were collected in 40 freedivers participating in an international deep freediving competition. SpO2 was measured within 17 ± 6 min and lung B-lines using ultrasound within 44 ± 15 min after surfacing. A specific symptoms questionnaire was used during SpO2 measurements. We found a negative correlation between B-line score and minimum SpO2 (rs = −0.491; p = 0.002) and mean SpO2 (rs = −0.335; p = 0.046). B-line scores were positively correlated with depth (rs = 0.408; p = 0.013), confirming that extra-vascular lung water is increased with deeper dives. Compared to dives that were asymptomatic, symptomatic dives had a 27% greater B-line score, and both a lower mean and minimum SpO2 (all p < 0.05). Indeed, a minimum SpO2 ≤ 95% after a deep dive has a positive predictive value of 29% and a negative predictive value of 100% regarding symptoms. We concluded that elevated B-line scores are associated with reduced SpO2 after dives, suggesting that SpO2 via pulse oximetry could be a useful screening tool to detect increased extra-vascular lung water. The practical application is not to diagnose pulmonary edema based on SpO2 – as pulse oximetry is inexact – rather, to utilize it as a tool to determine which divers require further evaluation before returning to deep freediving.
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Affiliation(s)
- Alexander Patrician
- Centre for Heart, Lung & Vascular Health, University of British Columbia, Okanagan, BC, Canada
| | - Frank Pernett
- Environmental Physiology Group, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | | | - Erika Schagatay
- Environmental Physiology Group, Department of Health Sciences, Mid Sweden University, Östersund, Sweden.,Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
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21
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Pulmonary Congestion Assessment in Heart Failure: Traditional and New Tools. Diagnostics (Basel) 2021; 11:diagnostics11081306. [PMID: 34441241 PMCID: PMC8394474 DOI: 10.3390/diagnostics11081306] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/16/2021] [Accepted: 07/18/2021] [Indexed: 12/28/2022] Open
Abstract
Congestion related to cardiac pressure and/or volume overload plays a central role in the pathophysiology, presentation, and prognosis of heart failure (HF). Most HF exacerbations are related to a progressive rise in cardiac filling pressures that precipitate pulmonary congestion and symptomatic decompensation. Furthermore, persistent symptoms and signs of congestion at discharge or among outpatients are strong predictors of an adverse outcome. Pulmonary congestion is also one of the most important diagnostic and therapeutic targets in chronic heart failure. The aim of this review is to analyze the importance of clinical, instrumental, and biochemical evaluation of congestion in HF by describing old and new tools. Lung ultrasonography (LUS) is an emerging method to assess pulmonary congestion. Accordingly, we describe the additive prognostic role of chest ultrasound with respect to traditional clinical and X-ray assessment in acute and chronic HF setting.
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22
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Iwakura K, Onishi T. A practical guide to the lung ultrasound for the assessment of congestive heart failure. J Echocardiogr 2021; 19:195-204. [PMID: 34133007 DOI: 10.1007/s12574-021-00528-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/01/2021] [Indexed: 11/24/2022]
Abstract
Dyspnea is one of the major symptoms encountered in the emergency department, and lung ultrasound (LUS) is recommended for the rapid diagnosis of the underlying disease. B-lines, the "comet-tail"-like vertical lines moving with respiration, are an ultrasound finding relevant to the pulmonary congestion. They may be observed in the normal lung, but bilateral, ≥ 3 B-lines are considered pathological. B-lines with lung sliding (B profile) are a specific sign of heart failure, while B-lines with abolished lung sliding (B' profile) are related with the lung diseases such as acute respiratory distress syndrome. B profile is reported to detect pulmonary edema with about 95% sensitivity and 95% specificity in patients with dyspnea. LUS also can assess the severity of pulmonary congestion semi-quantitatively by counting the number of B-lines or that of positive areas. Whereas the original BLUE protocol requires scanning at 12 zones on the chest, more rapid 8- or 6-zone scan is sufficient for the diagnosis of heart failure, and 2- or 4-zone scan may be used for the critical patients. LUS may be used for the evaluation of heart failure treatment, or can be performed as a part of exercise stress test. LUS can be performed easily and rapidly at the bedside using almost any kind of ultrasound apparatus, and it should be performed more widely in the daily practice as well as in the emergent department.
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Affiliation(s)
- Katsuomi Iwakura
- Division of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka, 5300001, Japan.
| | - Toshinari Onishi
- Division of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka, 5300001, Japan
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23
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Miger KC, Fabricius-Bjerre A, Maschmann CP, Wamberg J, Winkler Wille MM, Abild-Nielsen AG, Pedersen L, Lawaetz Schultz HH, Damm Nybing J, Nielsen OW. Clinical Applicability of Lung Ultrasound Methods in the Emergency Department to Detect Pulmonary Congestion on Computed Tomography. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2021; 42:e21-e30. [PMID: 31648347 DOI: 10.1055/a-1021-1470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND B-lines on lung ultrasound are seen in decompensated heart failure, but their diagnostic value in consecutive patients in the acute setting is not clear. Chest CT is the superior method to evaluate interstitial lung disease, but no studies have compared lung ultrasound directly to congestion on chest CT. PURPOSE To examine whether congestion on lung ultrasound equals congestion on a low-dose chest CT as the gold standard. MATERIALS AND METHODS In a single-center, prospective observational study we included consecutive patients ≥ 50 years of age in the emergency department. Patients were concurrently examined by lung ultrasound and chest CT. Congestion on lung ultrasound was examined in three ways: I) the total number of B-lines, II) ≥ 3 B-lines bilaterally, III) ≥ 3 B-lines bilaterally and/or bilateral pleural effusion. Congestion on CT was assessed by two specialists blinded to all other data. RESULTS We included 117 patients, 27 % of whom had a history of heart failure and 52 % chronic obstructive pulmonary disease. Lung ultrasound and CT were performed within a median time of 79.0 minutes. Congestion on CT was detected in 32 patients (27 %). Method I had an optimal cut-point of 7 B-lines with a sensitivity of 72 % and a specificity of 81 % for congestion. Method II had 44 % sensitivity, and 94 % specificity. Method III had a sensitivity of 88 % and a specificity of 85 %. CONCLUSION Pulmonary congestion in consecutive dyspneic patients ≥ 50 years of age is better diagnosed if lung ultrasound evaluates both B-lines and pleural effusion instead of B-lines alone.
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Affiliation(s)
- Kristina Cecilia Miger
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | | | - Christian Peter Maschmann
- Department of Emergency Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
- Department of Anesthesiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Jesper Wamberg
- Department of Emergency Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | | | | | - Lars Pedersen
- Department of Respiratory Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | | | - Janus Damm Nybing
- Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Olav Wendelboe Nielsen
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
- Copenhagen Center for Translational Research, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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24
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Laursen CB, Clive A, Hallifax R, Pietersen PI, Asciak R, Davidsen JR, Bhatnagar R, Bedawi EO, Jacobsen N, Coleman C, Edey A, Via G, Volpicelli G, Massard G, Raimondi F, Evison M, Konge L, Annema J, Rahman NM, Maskell N. European Respiratory Society statement on thoracic ultrasound. Eur Respir J 2021; 57:13993003.01519-2020. [PMID: 33033148 DOI: 10.1183/13993003.01519-2020] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/20/2020] [Indexed: 12/19/2022]
Abstract
Thoracic ultrasound is increasingly considered to be an essential tool for the pulmonologist. It is used in diverse clinical scenarios, including as an adjunct to clinical decision making for diagnosis, a real-time guide to procedures and a predictor or measurement of treatment response. The aim of this European Respiratory Society task force was to produce a statement on thoracic ultrasound for pulmonologists using thoracic ultrasound within the field of respiratory medicine. The multidisciplinary panel performed a review of the literature, addressing major areas of thoracic ultrasound practice and application. The selected major areas include equipment and technique, assessment of the chest wall, parietal pleura, pleural effusion, pneumothorax, interstitial syndrome, lung consolidation, diaphragm assessment, intervention guidance, training and the patient perspective. Despite the growing evidence supporting the use of thoracic ultrasound, the published literature still contains a paucity of data in some important fields. Key research questions for each of the major areas were identified, which serve to facilitate future multicentre collaborations and research to further consolidate an evidence-based use of thoracic ultrasound, for the benefit of the many patients being exposed to clinicians using thoracic ultrasound.
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Affiliation(s)
- Christian B Laursen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark .,Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Amelia Clive
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Rob Hallifax
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Pia Iben Pietersen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Regional Center for Technical Simulation, Odense University Hospital, Odense, Denmark
| | - Rachelle Asciak
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Jesper Rømhild Davidsen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,South Danish Center for Interstitial Lung Diseases (SCILS), Odense University Hospital, Odense, Denmark
| | - Rahul Bhatnagar
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Eihab O Bedawi
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Niels Jacobsen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Regional Center for Technical Simulation, Odense University Hospital, Odense, Denmark
| | | | - Anthony Edey
- Dept of Radiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Gabriele Via
- Cardiac Anesthesia and Intensive Care, Cardiocentro Ticino, Lugano, Switzerland
| | | | - Gilbert Massard
- Faculty of Science, Technology and Medicine, University of Luxembourg, Grand-Duchy of Luxembourg
| | - Francesco Raimondi
- Division of Neonatology, Section of Pediatrics, Dept of Translational Medical Sciences, Università "Federico II" di Napoli, Naples, Italy
| | - Matthew Evison
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Centre for HR, University of Copenhagen, Copenhagen, Denmark
| | - Jouke Annema
- Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK.,Laboratory of Pleural and Lung Cancer Translational Research, Nuffield Dept of Medicine, University of Oxford, Oxford, UK.,National Institute for Health Research, Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.,Joint last authors
| | - Nick Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK.,Southmead Hospital, North Bristol NHS Trust, Bristol, UK.,Joint last authors
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25
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Parras JI, Onocko M, Traviesa LM, Fernández EG, Morel PM, Cristaldo NG, Coronel ML, Macín SM, Perna ER. Lung ultrasound in acute myocardial infarction. Updating Killip & Kimball. Indian Heart J 2020; 73:104-108. [PMID: 33714393 PMCID: PMC7961256 DOI: 10.1016/j.ihj.2020.11.148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/08/2020] [Accepted: 11/20/2020] [Indexed: 12/22/2022] Open
Abstract
Background Heart failure complicating acute myocardial infarction marks an ominous prognosis. Killip and Kimball's classification of heart failure remains a useful tool in these patients. Lung ultrasound can detect pulmonary congestion but its usefulness in this scenario is unknown. Objective To investigate the diagnostic accuracy of lung ultrasound to predict heart failure in patients with acute myocardial infarction. Methods Patients admitted with acute myocardial infarction and without heart failure were evaluated with a lung ultrasound. The presence of B-lines was recorded and counted. The presence of new heart failure (Killip Class B, C, or D) during hospitalization was evaluated by a cardiologist blinded to the results of lung ultrasound. A ROC curve analysis was done to evaluate the diagnostic accuracy of B-lines to predict heart failure. Results 200 patients were included. Three patients were diagnosed with cardiogenic shock, 5 with acute pulmonary edema, and 17 with mild heart failure. Patients who develop heart failure had a median of 14 B-lines, however, patients who remained in Killip class A had a median of 2 (p = 0,0001). The area under the ROC curve of the sum of B-lines to predict any form of heart failure was 0,91 (CI95% 86–97). The best cut-off value was 5 B-lines, with a sensitivity of 88% (IC95% 68,8–97,5) and specificity of 81% (IC95% 73,9–86,2). Conclusion Lung ultrasound done at admission can help to predict heart failure In patients with acute myocardial infarction.
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Affiliation(s)
- Jorge I Parras
- Coronary Care Unit, Instituto de Cardiología de Corrientes "Juana F. Cabral", Corrientes, Argentina.
| | - Mariela Onocko
- Coronary Care Unit, Instituto de Cardiología de Corrientes "Juana F. Cabral", Corrientes, Argentina
| | - Liliana M Traviesa
- Emergency Department, Instituto de Cardiología de Corrientes "Juana F. Cabral", Corrientes, Argentina
| | - Eva G Fernández
- Emergency Department, Instituto de Cardiología de Corrientes "Juana F. Cabral", Corrientes, Argentina
| | - Pablo M Morel
- Emergency Department, Instituto de Cardiología de Corrientes "Juana F. Cabral", Corrientes, Argentina
| | - Natalia G Cristaldo
- Emergency Department, Instituto de Cardiología de Corrientes "Juana F. Cabral", Corrientes, Argentina
| | - María L Coronel
- Coronary Care Unit, Instituto de Cardiología de Corrientes "Juana F. Cabral", Corrientes, Argentina
| | - Stella M Macín
- Coronary Care Unit, Instituto de Cardiología de Corrientes "Juana F. Cabral", Corrientes, Argentina
| | - Eduardo R Perna
- Coronary Care Unit, Instituto de Cardiología de Corrientes "Juana F. Cabral", Corrientes, Argentina
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26
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Are pocket sized ultrasound devices sufficient in the evaluation of lung ultrasound patterns and aeration scoring in pulmonary ICU patients? J Clin Monit Comput 2020; 35:1491-1499. [PMID: 33170405 PMCID: PMC7653453 DOI: 10.1007/s10877-020-00617-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 11/02/2020] [Indexed: 12/16/2022]
Abstract
Lung ultrasound (LUS) is a practical diagnostic tool for several lung pathologies. Pocket sized USG devices (PSUDs) are more affordable, accessible, practical, and learning to use them is easier than standard ultrasound devices (SUDs). Their capability in image quality have been found as comparable with standard USG machines. Studies have been showing that these devices can be useful as much as SUDs in the evaluation of heart, abdomen, vascular structures, diaphragm and optic nerve. The aim of this study is to compare PSUD with a standard ultrasound devices (SUD) in the evaluation of LUS patterns such as alveolar, interstitial syndromes and lung aeration score (LAS). Study performed in an University Hospital Pulmonary ICU. All patients older than 18 years old were included in this study. The sector probe of SUD (Vivid-Q) and PSUD (Vscan) were used for investigation of A lines, interstitial (B lines), alveolar syndromes (consolidation, hepatisation, air bronchograms) and pleural effusion. 33 patients were included in the study. When PSUD was compared with SUD in terms of total B2 count, and LAS in the right, left and both lung, there was an agreement without proportional bias according to Bland Altman test. There was also good inter class correlation coefficient value as greater than 0.8 and 0.7 between two physicians in terms of counting of total B1, B2, total B lines and calculating of total LAS for SUD and PSUD respectively. PSUDs is a reliable and valid method for evaluation of LUS patterns like SUDs.
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27
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Ward JL, Lisciandro GR, Ware WA, Miles KG, Viall AK, DeFrancesco TC. Lung ultrasonography findings in dogs with various underlying causes of cough. J Am Vet Med Assoc 2020; 255:574-583. [PMID: 31429645 DOI: 10.2460/javma.255.5.574] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To characterize lung ultrasonography (LUS) findings in dogs with a primary clinical complaint of cough. ANIMALS 100 client-owned coughing dogs. PROCEDURES A standardized LUS examination was performed for all dogs to quantify the number of B lines and identify subpleural abnormalities at 4 sites on each hemithorax. The final clinical diagnosis (reference standard) was determined by medical record review, and sensitivity and specificity of LUS for the diagnosis of selected causes of cough was determined. RESULTS Common underlying causes of cough included dynamic airway collapse (n = 37), cardiogenic pulmonary edema (CPE; 12), and bronchitis (10). Compared with dogs with other causes of cough, dogs with bacterial pneumonia (n = 7) were more likely to have subpleural shred signs, whereas dogs with pulmonary neoplasia (4) were more likely to have subpleural nodule signs. Dogs with CPE had higher total B-line scores and higher numbers of LUS sites strongly positive for B lines (> 3 B lines/site) than other dogs. The LUS criteria of total B-line score ≥ 10 and presence of ≥ 2 sites strongly positive for B lines were each 92% sensitive and 94% specific for CPE diagnosis. Notably, 18% (16/88) of dogs with noncardiac causes of cough had been treated previously with diuretics because of prior CPE misdiagnosis. CONCLUSIONS AND CLINICAL RELEVANCE LUS profiles in dogs with cough differed by the underlying cause. In dogs with a clinical history of cough, this imaging modality could be diagnostically useful, particularly to help exclude the possibility of underlying CPE.
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28
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Arvig MD, Lassen AT, Gæde PH, Laursen CB. Monitoring patients with acute dyspnoea with a serial focused ultrasound of the heart and the lungs (MODUS): a protocol for a multicentre, randomised, open-label, pragmatic and controlled trial. BMJ Open 2020; 10:e034373. [PMID: 32499263 PMCID: PMC7279664 DOI: 10.1136/bmjopen-2019-034373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Among patients admitted to an emergency department, dyspnoea is one of the most common symptoms. Patients with dyspnoea have high mortality and morbidity. Therefore, novel methods to monitor the patients are warranted. The aim is to investigate whether therapy guided by monitoring patients with acute dyspnoea with serial ultrasound examinations of the heart and the lungs together with standard care can change the severity of dyspnoea compared with treatment guided by standard monitoring alone. METHODS AND ANALYSIS The study will be conducted as a multicentre, randomised, pragmatic, open-label and controlled trial where patients admitted with acute dyspnoea to an emergency ward will be randomised into a standard care group and a serial ultrasound group with 103 patients in each. All patients will be examined with an ultrasound of the heart and the lungs upfront. In addition, the patients in the serial ultrasound group will be examined with an ultrasound of the heart and lungs two more times to guide further therapy during the admittance. The primary outcome is a change in dyspnoea on a verbal scale. After discharge, the patients are followed for 1 year to assess the number of readmissions, death and length of hospital stay. ETHICS AND DISSEMINATION The trial is conducted in accordance with the Declaration of Helsinki and approved by The Regional Committee on Health Research Ethics for Region Zealand, Denmark (identifier SJ-744). Data handling agreement with participating centres has been made (identifier REG-056-2019). The General Data Protection Regulation and the Danish Data Protection Act will be respected. The results of the trial will be reported in peer-reviewed scientific journals regardless of the outcomes. TRIAL REGISTRATION NUMBER NCT04091334.
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Affiliation(s)
- Michael D Arvig
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Emergency Medicine, Slagelse Hospital, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Annmarie T Lassen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - Peter H Gæde
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark
| | - Christian B Laursen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
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29
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Brainin P, Claggett B, Lewis EF, Dwyer KH, Merz AA, Silverman MB, Swamy V, Biering-Sørensen T, Rivero J, Cheng S, McMurray JJV, Solomon SD, Platz E. Body mass index and B-lines on lung ultrasonography in chronic and acute heart failure. ESC Heart Fail 2020; 7:1201-1209. [PMID: 32077268 PMCID: PMC7261588 DOI: 10.1002/ehf2.12640] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/22/2020] [Indexed: 02/07/2023] Open
Abstract
AIMS Increased body mass index (BMI) is common in heart failure (HF) patients and is associated with lower levels of N-terminal pro-brain natriuretic peptide (NT-proBNP). We evaluated the influence of BMI on lung ultrasonography (LUS) findings indicative of pulmonary congestion (i.e. B-lines) in patients with chronic and acute HF (AHF). METHODS AND RESULTS We analysed ambulatory chronic HF (n = 118) and hospitalized AHF (n = 177) patients (mean age 70 years, 64% men, mean BMI 29 kg/m2 , mean ejection fraction 42%) undergoing echocardiography and LUS in eight chest zones. B-lines and chest wall thickness (skin to pleura) on ultrasound were quantified offline and blinded to clinical findings. NT-proBNP was available in AHF patients (n = 167). In chronic HF, B-line number decreased by 18% per 5 unit increase in BMI [95% confidence interval (CI) -35% to +5%, P = 0.11]. In AHF, the number of B-lines decreased by 12% per 5 unit increase in BMI (95% CI -19% to -5%, P = 0.001), whereas NT-proBNP concentration decreased by 28% per 5 unit increase in BMI (95% CI -40% to -16%, P < 0.001). For AHF, B-line number declined to a lesser degree than NT-proBNP concentration with increasing BMI (P = 0.020), and >6 B-lines were observed in half of AHF patients with severe obesity. There was an inverse relationship between B-line number and chest wall thickness, and this association varied by chest region. CONCLUSIONS Despite an inverse relationship between B-lines and BMI, B-lines declined to a lesser degree than NT-proBNP with increasing BMI. These data suggest that LUS may be useful in patients with HF despite obesity.
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Affiliation(s)
- Philip Brainin
- Department of Cardiology, Herlev and Gentofte University Hospital, Herlev, Denmark.,Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Neville House, Boston, MA, 02115, USA
| | - Brian Claggett
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Eldrin F Lewis
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Kristin H Dwyer
- Department of Emergency Medicine, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Montane B Silverman
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Neville House, Boston, MA, 02115, USA
| | - Varsha Swamy
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Neville House, Boston, MA, 02115, USA
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte University Hospital, Herlev, Denmark.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jose Rivero
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Susan Cheng
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Framingham Heart Study, Framingham, Massachusetts
| | - John J V McMurray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Elke Platz
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Neville House, Boston, MA, 02115, USA
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30
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Arystan AZ, Khamzina YT, Benberin VV, Fettser DV, Belenkov YN. [Lung Ultrasound: new Opportunities for a Cardiologist]. KARDIOLOGIIA 2020; 60:81-92. [PMID: 32245358 DOI: 10.18087/cardio.2020.1.n617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/13/2019] [Accepted: 09/17/2019] [Indexed: 06/11/2023]
Abstract
This review focused on ultrasound examination of lungs, a useful complement to transthoracic echocardiography (EchoCG), which is superior to chest X-ray in the diagnostic value. The lung acoustic window always remains open and allows obtaining high-quality images in most cases. For a cardiologist, the major points of the method application are determination of pleural effusion and lung congestion. This method has a number of advantages: it is time-saving; cost-effective; portable and accessible; can be used in a real-time mode; not associated with radiation; reproducible; and highly informative. The ultrasound finding of wet lungs would indicate threatening, acute cardiac decompensation long before appearance of clinical, auscultative, and radiological signs of lung congestion. Modern EchoCG should include examination of the heart and lungs as a part of a single, integrative ultrasound examination.
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Affiliation(s)
- A Z Arystan
- Medical Centre Hospital of the President's Affairs Administration of the Republic of Kazakhstan
| | - Y T Khamzina
- Medical Centre Hospital of the President's Affairs Administration of the Republic of Kazakhstan
| | - V V Benberin
- Medical Centre Hospital of the President's Affairs Administration of the Republic of Kazakhstan
| | - D V Fettser
- Municipal Clinical Hospital #52 at the Health Care Department of Moscow City
| | - Y N Belenkov
- I.M. Sechenov First Moscow State Medical University
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31
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Lindner M, Thomas R, Claggett B, Lewis EF, Groarke J, Merz AA, Silverman MB, Swamy V, Rivero J, Hohenstein C, Solomon SD, McMurray JJ, Steigner ML, Platz E. Quantification of pleural effusions on thoracic ultrasound in acute heart failure. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:513-521. [PMID: 31976745 DOI: 10.1177/2048872620901835] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although pleural effusions are common among patients with acute heart failure, the relevance of pleural effusion size assessed on thoracic ultrasound has not been investigated systematically. METHODS In this prospective observational study, we included patients hospitalised for acute heart failure and performed a thoracic ultrasound early after admission (thoracic ultrasound 1) and at discharge (thoracic ultrasound 2) independently of routine clinical management. A semiquantitative score was applied offline blinded to clinical findings to categorise and monitor pleural effusion size. RESULTS Among 188 patients (median age 72 years, 62% men, 78% white, median left ventricular ejection fraction 38%), pleural effusions on thoracic ultrasound 1 were present in 66% of patients and decreased in size during the hospitalisation in 75% based on the pleural effusion score (P<0.0001). Higher values of the pleural effusion score were associated with higher pleural effusion volumes on computed tomography (P<0.001), higher NT-pro brain natriuretic peptide values (P=0.001) and a greater number of B-lines on lung ultrasound (P=0.004). Nevertheless, 47% of patients were discharged with persistent pleural effusions, 19% with large effusions. However, higher values of the pleural effusion score on thoracic ultrasound 2 did not identify patients at increased risk of 90-day heart failure rehospitalisations or death (adjusted hazard ratio (HR) 1.05, 95% confidence interval (CI) 0.92-1.19; P=0.46) whereas seven or more B-lines on lung ultrasound at discharge were independently associated with adverse events (adjusted HR 2.43, 95% CI 1.11-5.37; P=0.027). CONCLUSION Among patients with acute heart failure, pleural effusions are associated with other clinical, imaging and laboratory markers of congestion and improve with heart failure therapy. The prognostic relevance of persistent pleural effusions at discharge should be investigated in larger studies.
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Affiliation(s)
- Moritz Lindner
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA.,Friedrich-Schiller-University Jena, Germany
| | - Richard Thomas
- Department of Radiology, Brigham and Women's Hospital, Boston, USA.,Harvard Medical School, Boston, USA
| | - Brian Claggett
- Harvard Medical School, Boston, USA.,Cardiovascular Division, Brigham and Women's Hospital, Boston, USA
| | - Eldrin F Lewis
- Harvard Medical School, Boston, USA.,Cardiovascular Division, Brigham and Women's Hospital, Boston, USA
| | - John Groarke
- Harvard Medical School, Boston, USA.,Cardiovascular Division, Brigham and Women's Hospital, Boston, USA
| | - Allison A Merz
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA.,Harvard Medical School, Boston, USA
| | - Montane B Silverman
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA.,Harvard Medical School, Boston, USA
| | - Varsha Swamy
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA.,Harvard Medical School, Boston, USA
| | - Jose Rivero
- Harvard Medical School, Boston, USA.,Cardiovascular Division, Brigham and Women's Hospital, Boston, USA
| | | | - Scott D Solomon
- Harvard Medical School, Boston, USA.,Cardiovascular Division, Brigham and Women's Hospital, Boston, USA
| | - John Jv McMurray
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, UK
| | - Michael L Steigner
- Department of Radiology, Brigham and Women's Hospital, Boston, USA.,Harvard Medical School, Boston, USA
| | - Elke Platz
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA.,Harvard Medical School, Boston, USA
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Cox EGM, Koster G, Baron A, Kaufmann T, Eck RJ, Veenstra TC, Hiemstra B, Wong A, Kwee TC, Tulleken JE, Keus F, Wiersema R, van der Horst ICC. Should the ultrasound probe replace your stethoscope? A SICS-I sub-study comparing lung ultrasound and pulmonary auscultation in the critically ill. Crit Care 2020; 24:14. [PMID: 31931844 PMCID: PMC6958607 DOI: 10.1186/s13054-019-2719-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 12/23/2019] [Indexed: 11/10/2022] Open
Abstract
Background In critically ill patients, auscultation might be challenging as dorsal lung fields are difficult to reach in supine-positioned patients, and the environment is often noisy. In recent years, clinicians have started to consider lung ultrasound as a useful diagnostic tool for a variety of pulmonary pathologies, including pulmonary edema. The aim of this study was to compare lung ultrasound and pulmonary auscultation for detecting pulmonary edema in critically ill patients. Methods This study was a planned sub-study of the Simple Intensive Care Studies-I, a single-center, prospective observational study. All acutely admitted patients who were 18 years and older with an expected ICU stay of at least 24 h were eligible for inclusion. All patients underwent clinical examination combined with lung ultrasound, conducted by researchers not involved in patient care. Clinical examination included auscultation of the bilateral regions for crepitations and rhonchi. Lung ultrasound was conducted according to the Bedside Lung Ultrasound in Emergency protocol. Pulmonary edema was defined as three or more B lines in at least two (bilateral) scan sites. An agreement was described by using the Cohen κ coefficient, sensitivity, specificity, negative predictive value, positive predictive value, and overall accuracy. Subgroup analysis were performed in patients who were not mechanically ventilated. Results The Simple Intensive Care Studies-I cohort included 1075 patients, of whom 926 (86%) were eligible for inclusion in this analysis. Three hundred seven of the 926 patients (33%) fulfilled the criteria for pulmonary edema on lung ultrasound. In 156 (51%) of these patients, auscultation was normal. A total of 302 patients (32%) had audible crepitations or rhonchi upon auscultation. From 130 patients with crepitations, 86 patients (66%) had pulmonary edema on lung ultrasound, and from 209 patients with rhonchi, 96 patients (46%) had pulmonary edema on lung ultrasound. The agreement between auscultation findings and lung ultrasound diagnosis was poor (κ statistic 0.25). Subgroup analysis showed that the diagnostic accuracy of auscultation was better in non-ventilated than in ventilated patients. Conclusion The agreement between lung ultrasound and auscultation is poor. Trial registration NCT02912624. Registered on September 23, 2016.
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Affiliation(s)
- Eline G M Cox
- Department of Critical Care, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Geert Koster
- Department of Critical Care, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Aidan Baron
- Emergency, Cardiovascular, and Critical Care Research Group, Centre for Health and Social Care Research, Kingston University and St George's University, London, UK
| | - Thomas Kaufmann
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ruben J Eck
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - T Corien Veenstra
- Department of Critical Care, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Bart Hiemstra
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Adrian Wong
- Department of Anaesthesiology and Intensive Care, Royal Surrey County Hospital, Guildford, UK
| | - Thomas C Kwee
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jaap E Tulleken
- Department of Critical Care, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Frederik Keus
- Department of Critical Care, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Renske Wiersema
- Department of Critical Care, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care, Maastricht University Medical Center+, Maastricht University, Maastricht, The Netherlands
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Chiumello D, Sferrazza Papa GF, Artigas A, Bouhemad B, Grgic A, Heunks L, Markstaller K, Pellegrino GM, Pisani L, Rigau D, Schultz MJ, Sotgiu G, Spieth P, Zompatori M, Navalesi P. ERS statement on chest imaging in acute respiratory failure. Eur Respir J 2019; 54:13993003.00435-2019. [PMID: 31248958 DOI: 10.1183/13993003.00435-2019] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/16/2019] [Indexed: 12/17/2022]
Abstract
Chest imaging in patients with acute respiratory failure plays an important role in diagnosing, monitoring and assessing the underlying disease. The available modalities range from plain chest X-ray to computed tomography, lung ultrasound, electrical impedance tomography and positron emission tomography. Surprisingly, there are presently no clear-cut recommendations for critical care physicians regarding indications for and limitations of these different techniques.The purpose of the present European Respiratory Society (ERS) statement is to provide physicians with a comprehensive clinical review of chest imaging techniques for the assessment of patients with acute respiratory failure, based on the scientific evidence as identified by systematic searches. For each of these imaging techniques, the panel evaluated the following items: possible indications, technical aspects, qualitative and quantitative analysis of lung morphology and the potential interplay with mechanical ventilation. A systematic search of the literature was performed from inception to September 2018. A first search provided 1833 references. After evaluating the full text and discussion among the committee, 135 references were used to prepare the current statement.These chest imaging techniques allow a better assessment and understanding of the pathogenesis and pathophysiology of patients with acute respiratory failure, but have different indications and can provide additional information to each other.
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Affiliation(s)
- Davide Chiumello
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy.,Dipartimento di Scienze della Salute, Centro Ricerca Coordinata di Insufficienza Respiratoria, Università degli Studi di Milano, Milan, Italy
| | | | - Antonio Artigas
- Corporacion Sanitaria, Universitaria Parc Tauli, CIBER de Enfermedades Respiratorias Autonomous University of Barcelona, Sabadell, Spain.,Intensive Care Dept, University Hospitals Sagrado Corazon - General de Cataluna, Quiron Salud, Barcelona-Sant Cugat del Valles, Spain
| | - Belaid Bouhemad
- Service d'Anesthésie - Réanimation, Université Bourgogne - Franche Comtè, lncumr 866L, Dijon, France
| | - Aleksandar Grgic
- Dept of Nuclear Medicine, Saarland University Medical Center, Homburg, Germany
| | - Leo Heunks
- Dept of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Klaus Markstaller
- Dept of Anesthesia, General Intensive Care Medicine and Pain Therapy, Medical University of Vienna, Vienna, Austria
| | - Giulia M Pellegrino
- Dipartimento di Scienze della Salute, Centro Ricerca Coordinata di Insufficienza Respiratoria, Università degli Studi di Milano, Milan, Italy.,Casa di Cura del Policlinico, Dipartimento di Scienze Neuroriabilitative, Milan, Italy
| | - Lara Pisani
- Respiratory and Critical Care Unit, Alma Mater Studiorum, University of Bologna, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | | | - Marcus J Schultz
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Dept of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Peter Spieth
- Dept of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Center for Clinical Research and Management Education, Division of Health Care Sciences, Dresden International University, Dresden, Germany
| | | | - Paolo Navalesi
- Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, University of Magna Graecia, Catanzaro, Italy
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Bailón MM, Rodrigo JMC, Lorenzo-Villalba N, Cerqueiro JM, García JC, Manuel EC, Martín-Sánchez FJ, Freire RB, Romano PC, Espinosa LM, Arévalo-Lorido JC, Rojo JMC, Macho JT. Effect of a Therapeutic Strategy Guided by Lung Ultrasound on 6-Month Outcomes in Patients with Heart Failure: Randomized, Multicenter Trial (EPICC Study). Cardiovasc Drugs Ther 2019; 33:453-459. [PMID: 31332655 DOI: 10.1007/s10557-019-06891-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES Pulmonary congestion (PC) is associated with an increased risk of hospitalization and death in patients with heart failure (HF). Lung ultrasound has shown to be highly sensitive for detecting PC in HF. The aim of this study is to evaluate whether lung ultrasound-guided therapy improves 6-month outcomes in patients with HF compared with conventional treatment. MATERIALS AND METHODS Randomized, multicenter, single-blind clinical trial in patients discharged from Internal Medicine Departments after hospitalization for decompensated HF. Participants will be assigned 1:1 to receive treatment guided according to the presence of lung ultrasound signs of congestion (semi-quantitative evaluation of B lines and the presence of pleural effusion) versus clinical assessment of congestion. The primary outcome is the combination of cardiovascular death and readmission for HF at 6 months. CONCLUSIONS The results of this study will provide more evidence about the impact of lung ultrasound on treatment monitoring in patients with chronic HF.
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Affiliation(s)
- Manuel Méndez Bailón
- Internal Medicine Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IDISSC), Facultad de Medicina, Universidad Complutense, Avda. Prof. Martin Lago S/N, 28040, Madrid, Spain.
| | | | - Noel Lorenzo-Villalba
- Internal Medicine Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | - Jose Curbelo García
- Internal Medicine Department, Hospital Universitario La Princesa, Madrid, Spain
| | - Elpidio Calvo Manuel
- Internal Medicine Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IDISSC), Facultad de Medicina, Universidad Complutense, Avda. Prof. Martin Lago S/N, 28040, Madrid, Spain
| | - Francisco Javier Martín-Sánchez
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Ramon Bover Freire
- Cardiology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Pilar Cubo Romano
- Internal Medicine Department, Hospital Universitario Infanta Cristina, Parla, Madrid, Spain
| | | | | | - Jose Manuel Casas Rojo
- Internal Medicine Department, Hospital Universitario Infanta Cristina, Parla, Madrid, Spain
| | - Juan Torres Macho
- Internal Medicine Department, Hospital Universitario Infanta Cristina, Parla, Madrid, Spain
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Platz E, Jhund PS, Girerd N, Pivetta E, McMurray JJV, Peacock WF, Masip J, Martin-Sanchez FJ, Miró Ò, Price S, Cullen L, Maisel AS, Vrints C, Cowie MR, DiSomma S, Bueno H, Mebazaa A, Gualandro DM, Tavares M, Metra M, Coats AJS, Ruschitzka F, Seferovic PM, Mueller C. Expert consensus document: Reporting checklist for quantification of pulmonary congestion by lung ultrasound in heart failure. Eur J Heart Fail 2019; 21:844-851. [PMID: 31218825 DOI: 10.1002/ejhf.1499] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 05/01/2019] [Accepted: 05/02/2019] [Indexed: 12/25/2022] Open
Abstract
Lung ultrasound is a useful tool for the assessment of patients with both acute and chronic heart failure, but the use of different image acquisition methods, inconsistent reporting of the technique employed and variable quantification of 'B-lines,' have all made it difficult to compare published reports. We therefore need to ensure that future studies utilizing lung ultrasound in the assessment of heart failure adopt a standardized approach to reporting the quantification of pulmonary congestion. Strategies to improve patient care by use of lung ultrasound in the assessment of heart failure have been difficult to develop. In the present document, key aspects of standardization are discussed, including equipment used, number of chest zones assessed, the method of quantifying B-lines, the presence and timing of additional investigations (e.g. natriuretic peptides and echocardiography) and the impact of therapy. This consensus report includes a checklist to provide standardization in the preparation, review and analysis of manuscripts. This will serve as a guide for investigators and clinicians and enhance the quality and transparency of lung ultrasound research.
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Affiliation(s)
- Elke Platz
- Department of Emergency Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Pardeep S Jhund
- BHF Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Nicolas Girerd
- INSERM, Centre d'Investigations Cliniques Plurithématique, INSERM U1116, CHRU de Nancy, F-CRIN INI-CRCT, Université de Lorraine, Nancy, France
| | - Emanuele Pivetta
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Cancer Epidemiology Unit and CPO Piemonte, Department of Medical Sciences, University of Turin, Turin, Italy
| | - John J V McMurray
- BHF Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - W Frank Peacock
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Josep Masip
- ICU Department, Consorci Sanitari Integral, University of Barcelona, Barcelona, Spain.,Cardiology Department, Hospital Sanitas CIMA, Barcelona, Spain
| | - Francisco Javier Martin-Sanchez
- Department of Emergency Medicine, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Òscar Miró
- Department of Emergency Medicine, Hospital Clínic, and Institut de Recerca Biomàdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Susanna Price
- Royal Brompton & Harefield NHS Foundation Trust, NHLI, Imperial College, London, UK
| | - Louise Cullen
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Alan S Maisel
- Coronary Care Unit and Heart Failure Program, Veteran Affairs (VA) San Diego, San Diego, CA, USA
| | | | - Martin R Cowie
- Royal Brompton & Harefield NHS Foundation Trust, NHLI, Imperial College, London, UK
| | - Salvatore DiSomma
- Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, Sant'Andrea Hospital, University La Sapienza, Rome, Italy
| | - Hector Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Department of Cardiology and Cardiovascular Research Area, imas12 Research Institute; Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Alexandre Mebazaa
- University Paris Diderot; APHP Hôpitaux Universitaires Saint Louis Lariboisière; Inserm 942, Paris, France
| | - Danielle M Gualandro
- Heart Institute (INCOR), University of Sao Paulo Medical School, Sao Paulo, Brazil.,Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Mucio Tavares
- Heart Institute (INCOR), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, Public Health, University of Brescia, Brescia, Italy
| | | | - Frank Ruschitzka
- Department of Cardiology, University Heart Centre Zurich, Zurich, Switzerland
| | | | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
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Rana HK, Akhtar MR, Islam MB, Ahmed MB, Liò P, Quinn JMW, Huq F, Moni MA. Genetic effects of welding fumes on the development of respiratory system diseases. Comput Biol Med 2019; 108:142-149. [PMID: 31005006 DOI: 10.1016/j.compbiomed.2019.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The welding process releases potentially hazardous gases and fumes, mainly composed of metallic oxides, fluorides and silicates. Long term welding fume (WF) inhalation is a recognized health issue that carries a risk of developing chronic health problems, particularly respiratory system diseases (RSDs). Aside from general airway irritation, WF exposure may drive direct cellular responses in the respiratory system which increase risk of RSD, but these are not well understood. METHODS We developed a quantitative framework to identify gene expression effects of WF exposure that may affect RSD development. We analyzed gene expression microarray data from WF-exposed tissues and RSD-affected tissues, including chronic bronchitis (CB), asthma (AS), pulmonary edema (PE), lung cancer (LC) datasets. We built disease-gene (diseasome) association networks and identified dysregulated signaling and ontological pathways, and protein-protein interaction sub-network using neighborhood-based benchmarking and multilayer network topology. RESULTS We observed many genes with altered expression in WF-exposed tissues were also among differentially expressed genes (DEGs) in RSD tissues; for CB, AS, PE and LC there were 34, 27, 50 and 26 genes respectively. DEG analysis, using disease association networks, pathways, ontological analysis and protein-protein interaction sub-network suggest significant links between WF exposure and the development of CB, AS, PE and LC. CONCLUSIONS Our network-based analysis and investigation of the genetic links of WFs and RSDs confirm a number of genes and gene products are plausible participants in RSD development. Our results are a significant resource to identify causal influences on the development of RSDs, particularly in the context of WF exposure.
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Affiliation(s)
- Humayan Kabir Rana
- Department of Computer Science and Engineering, Green University of Bangladesh, Bangladesh
| | - Mst Rashida Akhtar
- Department of Computer Science and Engineering, Varendra University, Rajshahi, Bangladesh
| | - M Babul Islam
- Department of Applied Physics and Electronic Engineering, University of Rajshahi, Bangladesh
| | - Mohammad Boshir Ahmed
- School of Civil and Environmental Engineering, University of Technology Sydney, NSW, 2007, Australia
| | - Pietro Liò
- Computer Laboratory, The University of Cambridge, 15 JJ Thomson Avenue, Cambridge, UK
| | - Julian M W Quinn
- Bone Biology Division, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Fazlul Huq
- Discipline of Pathology, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Mohammad Ali Moni
- Bone Biology Division, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia; Discipline of Pathology, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia.
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Curbelo J, Rodriguez-Cortes P, Aguilera M, Gil-Martinez P, Martín D, Suarez Fernandez C. Comparison between inferior vena cava ultrasound, lung ultrasound, bioelectric impedance analysis, and natriuretic peptides in chronic heart failure. Curr Med Res Opin 2019; 35:705-713. [PMID: 30185067 DOI: 10.1080/03007995.2018.1519502] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Heart failure (HF) is an important healthcare problem. Knowing volume status in outpatients with chronic HF to adjust treatment and to avoid decompensations is a challenge. The aim of this study is comparing the usefulness of inferior vena cava (IVC) ultrasound, lung ultrasound, bioelectrical impedance analysis (BIA), and natriuretic peptides in the follow-up of outpatients with chronic HF. METHODS This was a prospective cohort study. Ninety-nine patients with chronic HF were included consecutively as they attended scheduled medical visits. The different techniques were performed on the day of the clinic visit, and the result was hidden from the patients and the responsible medical team. Follow-up time was 1 year. Outcome events checked were a combination of death or hospitalization, due to HF. RESULTS Thirty-six patients (36.4%) died or were hospitalized for HF. They had a significantly lower IVC collapse, and a greater number of lung B-lines and higher NTproBNP levels compared to patients who remained stable. There were no differences in the BIA parameters. After multivariable analysis, cut-off points of IVC collapse <30%, number of pulmonary B lines greater than 5, and NTproBNP levels greater than 2000 pg/ml were associated with increased risk of HF death or admission. NTproBNP had the best area under the curve. CONCLUSION Evaluation of congestion in outpatients with chronic HF may be based on NTproBNP, IVC ultrasound, or lung ultrasound; they are useful in identifying patients at high risk of hospitalization or death due to HF.
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Affiliation(s)
- Jose Curbelo
- a Internal Medicine Department, Hospital Universitario La Princesa , Madrid , Spain
- b Medicine Department, Universidad Autónoma de Madrid , Madrid , Spain
| | - Pablo Rodriguez-Cortes
- a Internal Medicine Department, Hospital Universitario La Princesa , Madrid , Spain
- b Medicine Department, Universidad Autónoma de Madrid , Madrid , Spain
| | - Maria Aguilera
- a Internal Medicine Department, Hospital Universitario La Princesa , Madrid , Spain
- b Medicine Department, Universidad Autónoma de Madrid , Madrid , Spain
| | - Paloma Gil-Martinez
- a Internal Medicine Department, Hospital Universitario La Princesa , Madrid , Spain
- b Medicine Department, Universidad Autónoma de Madrid , Madrid , Spain
| | - Daniel Martín
- a Internal Medicine Department, Hospital Universitario La Princesa , Madrid , Spain
- b Medicine Department, Universidad Autónoma de Madrid , Madrid , Spain
| | - Carmen Suarez Fernandez
- a Internal Medicine Department, Hospital Universitario La Princesa , Madrid , Spain
- b Medicine Department, Universidad Autónoma de Madrid , Madrid , Spain
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Bello G, Blanco P. Lung Ultrasonography for Assessing Lung Aeration in Acute Respiratory Distress Syndrome: A Narrative Review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:27-37. [PMID: 29732586 DOI: 10.1002/jum.14671] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/16/2018] [Accepted: 04/03/2018] [Indexed: 06/08/2023]
Abstract
Acute respiratory distress syndrome (ARDS) constitutes a high burden for intensive care units. Although several methods are proposed to monitor aeration in ARDS, availability, costs, simplicity, and hazards (eg, ionizing radiation) limit the use of many of them at patients' bedsides. Given the widespread use of lung ultrasonography (US) in intensive care units, research is growing regarding its use to monitor aeration in patients with ARDS. We reviewed the actual role of lung US in ARDS and its potential impact in practice. Lung US can be readily used for assessing aeration, although, as a main limitation, a normal lung cannot be distinguished from hyperinflation. Additionally, an improvement in aeration by lung US does not always correlate with an increase in oxygenation. Lung US can be considered the main imaging method for monitoring aeration in ARDS, but in view of its limitations, it should not be used in isolation. Further studies are needed to validate lung US in large ARDS populations.
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Affiliation(s)
- Gabriela Bello
- Intensive Care Unit, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
- Hospital Policial, Montevideo, Uruguay
| | - Pablo Blanco
- Ecodiagnóstico-Centro de Diagnóstico por Imágenes, Necochea, Argentina
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39
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Covic A, Siriopol D, Voroneanu L. Use of Lung Ultrasound for the Assessment of Volume Status in CKD. Am J Kidney Dis 2018; 71:412-422. [DOI: 10.1053/j.ajkd.2017.10.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 10/12/2017] [Indexed: 12/20/2022]
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40
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Martindale JL, Secko M, Kilpatrick JF, deSouza IS, Paladino L, Aherne A, Mehta N, Conigiliaro A, Sinert R. Serial Sonographic Assessment of Pulmonary Edema in Patients With Hypertensive Acute Heart Failure. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:337-345. [PMID: 28758715 PMCID: PMC5798430 DOI: 10.1002/jum.14336] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 04/21/2017] [Accepted: 04/24/2017] [Indexed: 05/13/2023]
Abstract
OBJECTIVES Objective measures of clinical improvement in patients with acute heart failure (AHF) are lacking. The aim of this study was to determine whether repeated lung sonography could semiquantitatively capture changes in pulmonary edema (B-lines) in patients with hypertensive AHF early in the course of treatment. METHODS We conducted a feasibility study in a cohort of adults with acute onset of dyspnea, severe hypertension in the field or at triage (systolic blood pressure ≥ 180 mm Hg), and a presumptive diagnosis of AHF. Patients underwent repeated dyspnea and lung sonographic assessments using a 10-cm visual analog scale (VAS) and an 8-zone scanning protocol. Lung sonographic assessments were performed at the time of triage, initial VAS improvement, and disposition from the emergency department. Sonographic pulmonary edema was independently scored offline in a randomized and blinded fashion by using a scoring method that accounted for both the sum of discrete B-lines and degree of B-line fusion. RESULTS Sonographic pulmonary edema scores decreased significantly from initial to final sonographic assessments (P < .001). The median percentage decrease among the 20 included patient encounters was 81% (interquartile range, 55%-91%). Although sonographic pulmonary edema scores correlated with VAS scores (ρ = 0.64; P < .001), the magnitude of the change in these scores did not correlate with each other (ρ = -0.04; P = .89). CONCLUSIONS Changes in sonographic pulmonary edema can be semiquantitatively measured by serial 8-zone lung sonography using a scoring method that accounts for B-line fusion. Sonographic pulmonary edema improves in patients with hypertensive AHF during the initial hours of treatment.
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Affiliation(s)
| | - Michael Secko
- Stony Brook University Hospital, Stony Brook, New York, USA
| | - John F Kilpatrick
- State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Ian S deSouza
- State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Lorenzo Paladino
- State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Andrew Aherne
- State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Ninfa Mehta
- State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Alyssa Conigiliaro
- State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Richard Sinert
- State University of New York Downstate Medical Center, Brooklyn, New York, USA
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41
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Collins SP, Levy PD, Fermann GJ, Givertz MM, Martindale JM, Pang PS, Storrow AB, Diercks DD, Michael Felker G, Fonarow GC, Lanfear DJ, Lenihan DJ, Lindenfeld JM, Frank Peacock W, Sawyer DM, Teerlink JR, Butler J. What's Next for Acute Heart Failure Research? Acad Emerg Med 2018; 25:85-93. [PMID: 28990334 DOI: 10.1111/acem.13331] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 09/29/2017] [Accepted: 10/01/2017] [Indexed: 12/11/2022]
Abstract
Each year over one million patients with acute heart failure (AHF) present to a United States emergency department (ED). The vast majority are hospitalized for further management. The length of stay and high postdischarge event rate in this cohort have changed little over the past decade. Therapeutic trials have failed to yield substantive improvement in postdischarge outcomes; subsequently, AHF care has changed little in the past 40 years. Prior research studies have been fragmented as either "inpatient" or "ED-based." Recognizing the challenges in identification and enrollment of ED patients with AHF, and the lack of robust evidence to guide management, an AHF clinical trials network was developed. This network has demonstrated, through organized collaboration between cardiology and emergency medicine, that many of the hurdles in AHF research can be overcome. The development of a network that supports the collaboration of acute care and HF researchers, combined with the availability of federally funded infrastructure, will facilitate more efficient conduct of both explanatory and pragmatic trials in AHF. Yet many important questions remain, and in this document our group of emergency medicine and cardiology investigators have identified four high-priority research areas.
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Affiliation(s)
- Sean P. Collins
- Department of Emergency Medicine Vanderbilt University Medical Center Nashville TN
| | - Phillip D. Levy
- Department of Emergency Medicine Wayne State University Detroit MI
| | - Gregory J. Fermann
- Department of Emergency Medicine University of Cincinnati Medical Center Cincinnati OH
| | | | | | - Peter S. Pang
- Department of Emergency Medicine Indiana University School of Medicine & Indianapolis EMS Indianapolis IN
| | - Alan B. Storrow
- Department of Emergency Medicine Vanderbilt University Medical Center Nashville TN
| | - Deborah D. Diercks
- Department of Emergency Medicine University of Texas Southwestern Medical Center Dallas TX
| | | | - Gregg C. Fonarow
- Division of Cardiology University of California Los Angeles Ronald Reagan Medical Center Los AngelesCA
| | | | - Daniel J. Lenihan
- Division of Cardiology Vanderbilt University Medical Center Nashville TN
| | | | - W. Frank Peacock
- Department of Emergency Medicine Baylor University Medical Center Houston TX
| | | | - John R. Teerlink
- Division of Cardiology University of California San Francisco and the San Francisco VA San Francisco CA
| | - Javed Butler
- Division of Cardiology Stony Brook University Medical Center Stony BrookNY
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42
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Platz E, Merz AA, Jhund PS, Vazir A, Campbell R, McMurray JJ. Dynamic changes and prognostic value of pulmonary congestion by lung ultrasound in acute and chronic heart failure: a systematic review. Eur J Heart Fail 2017; 19:1154-1163. [PMID: 28557302 DOI: 10.1002/ejhf.839] [Citation(s) in RCA: 157] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/12/2017] [Accepted: 03/16/2017] [Indexed: 12/23/2022] Open
Abstract
AIMS Pulmonary congestion is an important finding in patients with heart failure (HF) that can be quantified by lung ultrasound (LUS). We conducted a systematic review to describe dynamic changes in LUS findings of pulmonary congestion (B-lines) in HF and to examine the prognostic utility of B-lines in HF. METHODS AND RESULTS We searched online databases for studies conducted in patients with chronic or acute HF that used LUS to assess dynamic changes or the prognostic value of pulmonary congestion. We included studies in adult populations, published in English, and conducted in ≥25 patients. Of 1327 identified studies, 13 (25-290 patients) met the inclusion criteria: six reported on dynamic changes in LUS findings (438 patients) and seven on the prognostic value of B-lines in HF (953 patients). In acute HF, B-line number changed within as few as 3 h of HF treatment. In acute HF, ≥15 B-lines on 28-zone LUS at discharge identified patients at a more than five-fold risk for HF readmission or death. Similarly, in ambulatory patients with chronic HF, ≥3 B-lines on five- or eight-zone LUS marked those at a nearly four-fold risk for 6-month HF hospitalization or death. CONCLUSIONS Lung ultrasound findings change rapidly in response to HF therapy. This technique may represent a useful and non-invasive method to track dynamic changes in pulmonary congestion. Furthermore, residual congestion at the time of discharge in acute HF or in ambulatory patients with chronic HF may identify those at high risk for adverse events.
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Affiliation(s)
- Elke Platz
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Pardeep S Jhund
- British Heart Foundation, Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Ali Vazir
- Department of Cardiology and Critical Care, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Ross Campbell
- British Heart Foundation, Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - John J McMurray
- British Heart Foundation, Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Sambataro D, Sambataro G, Dal Bosco Y, Campagna D, Polosa R. Is there any role for thoracic ultrasound for interstitial lung disease underlying rheumatologic conditions? Intern Emerg Med 2017; 12:283-285. [PMID: 28260220 DOI: 10.1007/s11739-017-1642-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 02/24/2017] [Indexed: 01/22/2023]
Affiliation(s)
- Domenico Sambataro
- ArtroReuma srl, Outpatient of Rheumatology Accredited with National Health System, Corso San Vito 53, 95030, Mascalucia, CT, Italy.
- Institute of Internal and Emergency Medicine, Teaching Hospital "Policlinico, Vittorio Emanuele" University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
- , Via G. Vitale 1, 95028, Valverde, CT, Italy.
| | - Gianluca Sambataro
- ArtroReuma srl, Outpatient of Rheumatology Accredited with National Health System, Corso San Vito 53, 95030, Mascalucia, CT, Italy
- Institute of Internal and Emergency Medicine, Teaching Hospital "Policlinico, Vittorio Emanuele" University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Ylenia Dal Bosco
- Institute of Internal and Emergency Medicine, Teaching Hospital "Policlinico, Vittorio Emanuele" University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Davide Campagna
- Institute of Internal and Emergency Medicine, Teaching Hospital "Policlinico, Vittorio Emanuele" University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Riccardo Polosa
- Institute of Internal and Emergency Medicine, Teaching Hospital "Policlinico, Vittorio Emanuele" University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
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